J Korean Neurotraumatol Soc.  2008 Dec;4(2):57-61. 10.13004/jknts.2008.4.2.57.

The Significance of Pupillary Light Reflex of Patient in Barbiturate Coma Therapy

• Cho PG
• Whang K
• Pyen JS
• Hu C
• Hong SK
• Jung HH

• KMID: 2156150
• DOI: http://doi.org/10.13004/jknts.2008.4.2.57

Abstract

OBJECTIVE
The aim of this study was to examine the significance of pupillary light reflex (PLR) during barbiturate coma therapy (BCT) against severe brain swelling.
METHODS
Between January 2003 and October 2007, 28 patients (traumatic brain injury: 15) underwent BCT because of maintained severe brain swelling after operation. All the patients maintained 3-6th wave per minute activity on electro-encephalography, and PLR were checked every 2 hours during BCT. The patient's performance was checked using Glasgow outcome scale (GOS) at the average 19.6 days (1-60 days) after BCT.
RESULTS
Twenty one patients had PLR at the start of BCT. Among 21 patients, 12 patient's PLR were vanished during BCT. Nine of 12 patients were dead (GOS=1), two had severe disability (GOS=2), and one stayed persistent vegetative state (GOS=3). But other nine patient's group, who showed prompt PLR continuously during BCT, got more improved GOS, compared with PLR vanished patient's group; 7 of 9 patients ranked more than GOS score 3.
CONCLUSION
Our clinical data suggest that the maintaining prompt PLR during BCT is a positive finding to predict good outcome.

Keyword

Barbiturate coma therapy; Pupillary light reflex; Severe brain swelling

MeSH Terms

Barbiturates
Brain
Brain Edema
Coma
Glasgow Outcome Scale
Humans
Light
Persistent Vegetative State
Reflex
Barbiturates

Figure

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  FIGURE 1 A 33-year-old male patient, glasgow coma scale (GOS) score 7, was admitted due to traumatic brain injury and operated. To control increased intracranial pressure, barbiturate coma therapy was done and his final glasgow outcome scale score was 5. A: Effacement of ambient cistern and midline shifting is remained after decompressive craniectomy. B: Effacement of ambient cistern and midline shifting is recovered after 48 hours of barbiturate coma therapy on brain computed tomography examination.

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  FIGURE 2 All the patients maintained 3-6th wave per minute on electro-encephalography, with 5-7 µV/mm sensitivity.

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  FIGURE 3 Flow chart of patient's Glasgow outcome scale in barbiturate coma therapy.

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